Abstract
This prospective study investigates whether measurement of plasma intestinal-fatty acid binding protein (I-FABP), a sensitive marker for small intestinal epithelial damage, improves non-invasive diagnosing of celiac disease (CD), and whether I-FABP levels are useful to evaluate mucosal healing in patients on a gluten-free diet (GFD). Ninety children with elevated tTG-IgA titres and HLA-DQ2/DQ8 positivity were included (study group). Duodenal biopsies were taken, except in those fulfilling the ESPGHAN criteria. Plasma I-FABP levels and tTG-IgA titres were assessed sequentially during six months of follow-up. Eighty children with normal tTG-IgA titres served as control group. In 61/90 (67.8%) of the children in the study group an increased I-FABP level was found; in all these children CD diagnosis was confirmed. Interestingly, in 14/30 (46.7%) children with slightly elevated tTG-IgA titres (<10x upper limit of normal), an increased I-FABP level was found. In all these children the diagnosis of CD was confirmed histologically. After gluten elimination for six weeks I-FABP levels had decreased towards levels in the control group. Measurement of plasma I-FABP, in addition to tTG-IgA, EMA-IgA and HLAtyping, enables non-invasive diagnosing of CD in a substantial number of children, and might therefore be of value in the diagnostic approach of CD.
Highlights
Introduction of the revised guidelines forceliac disease (CD) by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) in 2012 has permitted a non-invasive diagnosis in selected patients2
The data show that use of plasma Intestinal-fatty acid binding protein (I-FABP) level might improve non-invasive diagnosing in children with elevated CD autoantibody titres and human leukocyte antigen (HLA)-DQ2 and/or -DQ8 positivity
Our results indicate that plasma I-FABP is a useful additional tool besides the currently used CD autoantibodies and genotyping for evaluation of disease activity at time of diagnosis, and may be useful for monitoring disease activity during follow-up
Summary
Introduction of the revised guidelines forCD by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) in 2012 has permitted a non-invasive diagnosis in selected patients. Child and its parents, while interpretation difficulties due to patchy lesions and inadequate biopsy specimen may occur3–6 Apart from these diagnostic concerns, a reliable marker to evaluate CD activity in patients on a GFD is needed. Our retrospective studies showed elevated levels of I-FABP in children and adults with untreated CD, and rapid recovery and normalization of these levels after initiation of a GFD16–18. The results of these studies suggest that elevated I-FABP levels in children with elevated CD autoantibody titres and an HLA-DQ2 and/or -DQ8 genotype confirm a diagnosis of CD, making a biopsy unnecessary. The retrospective study design hampered decision-making based on I-FABP level in these children, and hindered standardized follow-up of I-FABP levels after initiation of a GFD
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
